There are a number of conditions affecting the shoulder which cannot be very well treated by the traditional methods. Thankfully we now have a relatively new technique which has been giving spectacular results for these neglected patients.

There are lots of patients out there who have this condition without realising it. Usually they are elderly and sadly, and all too often, they present to their GP or rheumatologist (or even their shoulder surgeon!) with their stiff, painful shoulder only to be told that they have a ‘frozen shoulder’ (which they do not) or that ‘nothing can be done for them’ (when it certainly can!)
But a simple x-ray will tell the story. And then hopefully the patient will be referred on to someone like me who uses, and believes in, Reverse Geometry shoulder replacements.

  I have a very painful, stiff shoulder. Is it ‘frozen’?

Well, it might be. But Frozen Shoulder must NEVER be diagnosed without an xray or scan. In the last 6 months I have seen 3 patients who were sent to me as suffering with frozen shoulders and I fully expected them to have frozen shoulders after examining them. However the X-rays told a very different tale. All 3 had arthritis and have had new shoulder joints! So insist on an X-ray!

   Shoulder Arthritis                          An Uncemented Anatomical Replacement

Ok, so I have cuff-tear arthritis but why can’t I have a traditional shoulder replacement?

If the history, examination and imaging (X-ray, MRI) indicates a problem with the rotator cuff, then a traditional replacement will get rid of your pain but won’t improve your movement because you have to have intact and functioning tendons in order to move the new joint.

I’ve heard that this is a new operation and I don’t want to be experimented on!

That is one of the many myths about this procedure. In fact it has been around since 1991-which is actually a lot longer than many of the traditional artificial joints which may be offered
to you as an alternative.

I have also heard that the complication rate is quite high.

Another myth! Some doctors will tell you that there is a high infection rate, a high dislocation rate and a high failure rate. This is because we have tried to expand the boundaries of what this type of shoulder replacement can be used for and in some of these conditions it has not been so successful. So the bad results in those conditions get lumped together with the excellent results for other conditions giving the impression it has a high complication rate. There are some other political reasons why these rumours abound but this is not the place to discuss those!!
So the high complication rate is simply not true. All the published evidence tells us that, when used for its main indication of cuff-tear arthritis, the infection rate is no higher than in traditional shoulder replacement and they do not dislocate. They also seem to be lasting very well and continue to work without falling apart. So do not worry. 

It’s all in the design! Basically the normal shoulder mechanics are reversed (hence the name!) with a metal ball going where the socket was and a plastic socket replacing the ball. What this does is create a more stable or constrained joint which can then be moved by the Deltoid muscle alone - a normal or anatomical shoulder has to have an intact rotator-cuff as well as the deltoid. Anyway - it works!

How long will it last?

Like anything mechanical, and like any other artificial joint, it does have a finite life-span. The average age of my patients who have undergone this type of surgery is over 80! The oldest had one side done aged 91 and the other side when he was 93!

So there is a reasonable chance that it will see you out! I will do this operation in much younger patients (in their 50’s) when there is no other option. In this group I do an uncemented version because cement is the weak spot the same as it is for hips.

Tell me a bit about the surgery.

The operation takes about an hour and is done under a general anaesthetic. You only need to be in hospital for one or maybe two nights.

You will be in a sling for a month but can come out of this to move your elbow and, usually, you can start doing some exercises
straight away.

It can take about 6 months to get as good as you are going to get because you need to strength up the deltoid muscle which will have wasted away during the period when your shoulder wasn’t moving. However within two months you should fine that your arm is moving much better than before the surgery and, more importantly, with much less pain.

How good will it be?

I can’t give you back an entirely normal shoulder but generally there will only be minimal pain and excellent movement of the arm upwards. It isn’t great for getting your hand up behind your back though. Range of motion after Reverse Geometry Shoulder Replacement

And the risks?

The main risks I warn you of are infection, dislocation and longevity. In my cases for cufftear arthritis there has only been one infection and that was probably an error in patient selection on my part. One patient fell down stairs a year after surgery and knocked the ball off but I was able to reattach it and he has done very well. There have been no other dislocations in this group.
All operations carry a small risk of DVT (thrombosis in the calf muscles) and PE (a clot going to the lungs) but this is minimal.

Have you done many?

I am one of the leading exponents of Reverse Geometry Shoulder Arthroplasty in the UK (and perhaps even in the world?) and have one of the biggest experiences stretching back over the last 7 years.

What other conditions do you use this for?

I also advocate Reverse Geometry Shoulder replacements for massive rotator cuff tears even where there is no arthritis. This is because trying to fix old, chronic, retracted tendon tears can often be impossible, or takes several years to recover from or fails after a few months.

So my view is why mess about with all of that when a new shoulder will sort out all your problems much more easily. It is also used in revision surgery when a traditional replacement hasn’t worked - often because the rotator cuff was of poor quality and wears through with time - and works well in this condition but revision surgery of any joint does have a much higher complication rate.

So, if you are elderly and have a stiff, painful knee or hip your doctor will immediately think of arthritis and you will do very well with a new kne or hip. If you have a stiff, painful shoulder do not accept the diagnosis of frozen shoulder without an x-ray because if you are over 75 you may well have arthritis. And if you have cuff-tear arthritis then it can be very successfully dealt with using a Reverse Geometry Shoulder Replacement.